Sometimes it is difficult for therapists to see abnormalities in very 
young babies, because their tone is normally low. Does this therapist 
work with a lot of babies? That pistoning, thrusting motion of the 
tongue that you describe is not normal, nor is chewing on a bottle. Nor 
is nasal regurgitation. Perhaps an ENT could scope the baby to look at 
soft palate function (perhaps baby has velopharyngeal insufficiency). 
This is a subtle issue.

One thing you might try if the baby just needs help organizing the mouth 
around something preformed is to use a 24mm nipple shield, draw mom's 
breast well into it, and then put some milk in through the holes in 
front with a periodontal syringe. This worked well to get a baby with 
neonatal encephalopathy interested in the breast as a food source. He 
still sucked abnormally, but he took what was in the shield and learned 
that breasts make milk.

You can also talk to the therapist, and tell her what you are seeing 
that does not work for breastfeeding, and encourage her to think of ways 
to help the baby with behaviors that are good for breastfeeding. For 
example, therapists may worry a lot about lip seal on bottles, but for 
breasts, the tongue keeps most of the seal, the lips are much more open, 
and much more relaxed. So she could work on the cupping and grooving of 
the front of the tongue to help the baby attach to and stay on the breast.

And, take hope. Some of our colleagues who are therapists and IBCLCs are 
working hard to try to educate their therapist colleagues about 
breastfeeding. The more we work together and talk about good goals for 
bf infants, the better.
Catherine Watson Genna, IBCLC NYC

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